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| 血清皮质抑素、分拣蛋白、人类白细胞抗原-G与妊娠期糖尿病患者糖代谢紊乱、胰岛素抵抗的关系及对妊娠结局的影响 |
| Relationship Between Serum Cortistatin, Sortilin, Human Leukocyte Antigen-G and Glucose Metabolism Disorder,Insulin Resistance in Patients With Gestational Diabetes Mellitus and Their Effect on Pregnancy Outcome |
| 投稿时间：2023-03-13 修订日期：2023-03-13 |
| DOI： |
| 中文关键词: 妊娠期糖尿病 CST sortilin HLA-G 糖代谢紊乱 胰岛素抵抗 妊娠结局 |
| 英文关键词: Gestational diabetes mellitus CST sortilin HLA-G Glucose metabolism disorder Insulin resistance Pregnancy outcome |
| 基金项目:湖北省卫生计生委联合基金立项项目（WJ2019H0108） |
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| 中文摘要: |
| 目的 探讨血清皮质抑素（CST）、分拣蛋白（sortilin）、人类白细胞抗原-G（HLA-G）与妊娠期糖尿病（GDM）患者糖代谢紊乱、胰岛素抵抗的关系及对妊娠结局的影响。方法 选取2019年6月至2021年5月本院收治的333例GDM患者为研究组，另选取同期42例妊娠糖耐量正常的健康孕妇为对照组，比较两组研究对象糖代谢指标、胰岛素抵抗指标及血清CST、sortilin、HLA-G水平，采用Pearson相关性分析法分析糖代谢、胰岛素抵抗指标与血清CST、sortilin、HLA-G水平的相关性。根据随访期间的妊娠结局将GDM患者分为不良结局组与良好结局组，比较两组血清CST、sortilin、HLA-G水平及临床资料的差异，采用Logistic回归分析法明确导致GDM患者不良妊娠结局的危险因素。结果 研究组糖尿病家族史、合并高脂血症占比及空腹血糖（FPG）、服糖后1 h血糖（1hPG）、服糖后2 h血糖（2hPG）、糖化血红蛋白（HbAlc）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）及sortilin水平均高于对照组（P＜0.05），研究组血清CST、HLA-G水平低于对照组（P＜0.05）。GDM患者血清CST、HLA-G与FPG、2hPG、HbAlc、FINS、HOMA-IR均呈负相关（P<0.05），血清sortilin与FPG、2hPG、HbAlc、FINS、HOMA-IR均呈正相关（P<0.05）。研究组不良妊娠结局发生率为15.32%。不良结局组年龄≥35岁、孕前1个月体质量指数（BMI）≥24 kg/m2、有不良孕产史、糖尿病家族史、合并高脂血症、血糖控制不佳占比及血清sortilin水平均高于良好结局组，血清CST及HLA-G水平低于良好结局组（P＜0.05）。Logistic回归分析结果显示，年龄≥35岁、孕前1个月BMI≥24 kg/m2、血糖控制不佳、血清CST低水平、血清sortilin高水平、血清HLA-G低水平为GDM患者妊娠结局不良的危险因素（P＜0.05）。结论 GDM患者血清CST、sortilin、HLA-G与糖代谢紊乱、胰岛素抵抗及不良妊娠结局关系密切，提示临床在加强血糖监测和控制的同时，检测血清CST、sortilin、HLA-G可能有助于评估GDM患者病情和预测不良妊娠结局的发生风险。 |
| 英文摘要: |
| Objective To investigate the relationship between serum cortistatin (CST), sortilin, human leukocyte antigen-G (HLA-G) and glucose metabolism disorder, insulin resistance in patients with gestational diabetes mellitus (GDM) and their effect on pregnancy outcome. Methods 333 cases of patients with GDM who were admitted to our hospital from June 2019 to May 2021 were selected as the study group, and 42 cases of healthy pregnant women with normal gestational glucose tolerance during the same period were selected as the control group. Glucose metabolism indexes, insulin resistance indexes, and serum CST, sortilin, and HLA-G levels of subjects were compared between the two groups. The correlation between glucose metabolism, insulin resistance indexes and serum CST, sortilin and HLA-G levels was analyzed by Pearson correlation analysis method. The patients with GDM were divided into poor outcome group and good outcome group according to the pregnancy outcome during the follow-up period, and the differences in serum CST, sortilin, HLA-G levels and clinical data were compared between the two groups, and Logistic regression analysis was used to determine the risk factors for poor pregnancy outcome in patients with GDM. Results The proportion of family history of diabetes, complicated hyperlipidemia and the fasting plasma glucose (FPG), 1h postprandial blood glucose (1hPG), 2h postprandial blood glucose (2hPG), glycosylated hemoglobin (HbAlc), fasting insulin (FINS), insulin resistance index (HOMA-IR) and sortilin levels in the study group were higher than those in the control group (P＜0.05), and the serum CST and HLA-G levels in the study group were lower than those in the control group (P＜0.05). Serum CST and HLA-G of patients with GDM were negatively correlated with FPG, 2hPG, HbAlc, FINS, and HOMA-IR (P<0.05), and serum sortilin was positively correlated with FPG, 2hPG, HbAlc, FINS and HOMA-IR (P<0.05). The incidence of poor pregnancy outcome in the study group was 15.32%. The proportion of age ≥35 years old, 1 month before pregnancy body mass index (BMI)≥24 kg/m2, adverse pregnancy history, family history of diabetes, complicated hyperlipidemia, poor blood glucose control and serum sortilin level in the poor outcome group were higher than those in the good outcome group, and serum CST and HLA-G levels were lower than those in the good outcome group (P<0.05). Logistic regression analysis showed that age ≥35 years old, 1 month before pregnancy BMI ≥24 kg/m2, poor blood glucose control, low serum CST level, high serum sortilin level and low serum HLA-G level were risk factors for poor pregnancy outcome in patients with GDM (P＜0.05). Conclusion Serum CST, sortilin and HLA-G in patients with GDM are closely related to glucose metabolism disorder, insulin resistance and poor pregnancy outcome, suggesting that while strengthening blood glucose monitoring and control, the detection of serum CST, sortilin and HLA-G is helpful for evaluating the condition of patients with GDM and predicting the risk of poor pregnancy outcome. |
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